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Antacid therapy for acid indigestion is a multi-billion dollar industry in the United States. Remedies range from over-the-counter antacid tablets to strong acid suppression medications available only by prescription. The antacids most commonly prescribed are called H2 Blockers, and these have been available now for nearly twenty years. They have few side effects and are available over-the-counter. They often give relief of symptoms, but they may not be effective in reducing the damage done by reflux disease. Many people have taken these drugs for years, at substantial expense. Other drugs are termed prokinetic agents, which are thought to promote the emptying of the stomach. These have been shown to be helpful in diminishing the symptoms of reflux, but may not be effective in the control of the disease. Several other gastric acid secretion inhibitors have been used for this disease, but may be dangerous if used for long periods of time.

Disadvantages of Non-Surgical Treatment of Gastroesophageal Reflux Disease

Prolonged reflux disease is associated with multiple complications including ulcerations of the lower esophagus, called reflux esophagitis. These ulcerations can bleed and perforate causing a life-threatening emergency. More commonly seen is scarring of the esophagus and the formation of strictures. These strictures obstruct the flow of food through the esophagus which leads to increased difficulty with swallowing.

Approximately twenty percent of people with prolonged gastroesophageal reflux disease develop what is called Barrett's esophagus. This is a transformation of the normal lining of the lower esophagus into a different tissue which is normally found only in the stomach, called the columnar epithelium. The danger associated with this transformation is that it sometimes progresses to cancer. The subsequent cancer is called adenocarcinoma of the esophagus, rather than squamous cell carcinoma of the esophagus which was formerly the most common type.

In recent years adenocarcinoma of the lower esophagus has become much more common. In fact, according to the National Institutes of Health, the rate at which this disease is occurring is increasing faster than any other cancer in the last twenty years.

The important thing to remember is that this cancer is always curable if it is found early, and for this reason anyone with prolonged symptoms or signs of reflux disease should be thoroughly evaluated.

It is not enough just to suppress the acid in the stomach with medication to prevent damage to the lower esophagus. The reflux occurs because of a structural fault which allows the stomach juice to continue to wash back into the esophagus, causing damage without the person being aware of it. More reflux sufferers than ever before have been on strong acid suppression therapy and have not been referred for surgery. It is possible that because of non-surgical treatment, Barrett's esophagus is occurring more frequently than ever before and that this has led to the increasing rate of cancer.

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